Kole procedure

Introduction:

Kole in 1959 published his series on subapical osteotomy for the correction of anterior open bite deformity. The conventional Kole osteotomy an alter the symmetric bone architecture of the chin and jeopardize the blood supply of the sandwich segments. Thus, Modified Kole procedure close anterior open bite as well as correct anterior and vertical macrogenia without sacrificing the lower most symphyseal segment, in comparison with conventional Kole's osteotomy.

This procedure can be used for the correction of localized deformities such as mild to severe open bites and similar major asymmetric segmental deformities.

Surgical Technique:

• The subapical osteotomy cuts were made between the first and second premolar without extractions.
• The subapical osteotomy segment is repositioned superiorly as in standard Kole's technique to correct the open bite.
• A low level genioplasty is performed to remove a wedge shaped bicortical bone. 
• This bone wedge was used to fill the defect below the subapical bone defect (subapical sandwich with vertical and anterior genial correction)
• An intraoral symmetrical soft tissue excision also was done to improve the chin's soft tissue profile.

Advantages:

• correction of open bite as well as vertical genioplasty in one surgical appointment
• correction of soft tissue contours
• maintenance of blood supply soon after surgery
• no extractions required

Disadvantages:

• High technique sensitive
• injury to mental nerves is a possibility resulting into loss of sensation in chin and anterior teeth.

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